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A new drug combo is turning heads in biliary tract cancer treatment. The phase 2/3 COMPANION-002 trial found that tovecimig — a first-in-class bispecific antibody — combined with paclitaxel nearly tripled response rates compared to paclitaxel alone (18% vs. 5.3%) in previously treated patients. PFS also improved significantly, though overall survival data were complicated by a high crossover rate.
A new drug combination is offering hope for patients with advanced biliary tract cancer, one of oncology's toughest challenges. The phase 2/3 COMPANION-002 trial showed that tovecimig (CTX-009) — a bispecific antibody targeting both VEGF-A and DLL4 — combined with paclitaxel nearly tripled objective response rates compared to paclitaxel alone (18% vs. 5.3%), meeting the trial's primary endpoint. Progression-free survival also improved meaningfully, at 4.7 months vs. 2.6 months. Results were presented at the 2026 ESMO Congress and simultaneously published in the Journal of Clinical Oncology.
The overall survival data, however, told a more complicated story. Median OS was similar between arms (8.9 vs. 9.4 months), but 54% of patients in the control arm crossed over to receive tovecimig — likely masking any true survival benefit. Among crossover patients, median OS reached 12.8 months vs. just 6.1 months for those who didn't cross over.
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Why it matters: Biliary tract cancers are aggressive and carry a poor prognosis, with few effective second-line options. While experts note that a phase 3 trial with FOLFOX as the comparator and a clear OS benefit would be ideal, the high unmet need and promising mechanism make tovecimig a strong candidate for formal guideline review.
